April 27, 2018
Despite coming face-to-face with mass shootings, motor vehicle accidents, blasts and burns in the news, it can be easy for members of the public to tune out, putting down their phones or walking away from the TV to attend to other facets of their busy lives.
"It's one of those hidden-in-plain-sight kind of issues — trauma is the leading cause of death for individuals up to age 45, and that statistic is often in the introductory paragraph for every paper in the trauma literature regarding injury prevention," says Brian D. Kim, M.D., a trauma surgeon and adult trauma medical director at Mayo Clinic in Rochester, Minnesota. "Trauma is a huge public health issue that is sometimes overlooked. For being the leading cause of death, often people don't think about it until they are faced with it personally — it's underappreciated until it hits home."
What the public needs to know
There are several aspects of traumatic injury critical for the public to appreciate, such as its scope and potential preventability, the role the public can play, and the importance of early intervention and how to intervene.
Scope and potential preventability of trauma
First of all, it's crucial that citizens understand the scope of traumatic injury in the U.S. Beyond its ranking as the leading cause of death for younger people, the National Trauma Institute indicates trauma accounts for over 150,000 U.S. deaths and more than 3 million nonfatal injuries yearly, in some cases leading to a permanent quality-of-life decline and years of lost productivity.
It's the fourth-leading cause of death overall for all ages, according to the American Association for the Surgery of Trauma and the National Center for Health Statistics at the Centers for Disease Control and Prevention (CDC). Every hour of the day, a child dies from injury in the U.S., according to the CDC.
Police-reported motor vehicle crashes totaled 6,296,000 in 2015, taking the lives of 35,092 people and injuring 2,443,000 more, according to the National Highway Traffic Safety Administration.
Citizens also need to be aware that in some cases, traumatic injury or death — not to mention the associated health care expenses — should never occur at all. "The thing about trauma death is that a subset is preventable — that's what's maddening about trauma," says Dr. Kim. "But for safety measures and education, these individuals would be alive."
Role they can play and importance of early intervention
In order to make an impact on reducing and preventing trauma, citizens must be aware not only of trauma, but also of the role they can play in saving the life or quality of life for injured people they may encounter even before first responders arrive. The people around the victim at the time of the incident are called immediate responders.
"The media has highlighted citizen efforts, like the man in the cowboy hat at the Boston Marathon bombing who was escorting and pushing people in wheelchairs — the face of the immediate responder," says Dr. Kim. "It has become increasingly appreciated that there are civilian heroes and that trauma can happen anywhere.
"We typically think of first responders as EMS or ambulance crews. However, despite extraordinary response times from first responders, sometimes they can't get to the injured. Immediate responders, however, may be right there: a civilian bystander who can get to the individual first. To intervene in that kind of situation — that's absolutely the right thing to do, if it's safe to intervene."
An awareness and understanding that early intervention can make a significant difference in such situations is what the American Trauma Society, in collaboration with the Society of Trauma Nurses, hopes to accomplish with its annual May National Trauma Awareness Month and the American College of Surgeons (ACS) intends with its Stop the Bleed campaign.
"Trauma is very time-sensitive," says Terri A. Elsbernd, R.N., pediatric trauma coordinator at Mayo Clinic Trauma Center in Rochester, Minnesota. "Early interventions can improve outcomes, so helping injured patients quickly and moving patients expeditiously is imperative."
Dr. Kim cites a 2017 case where an individual working with a table saw injured his upper extremity and was hemorrhaging. The tourniquet EMTs applied to this patient helped salvage the limb and allowed the individual to arrive at the hospital with limited damage. This is significant in that untreated hemorrhage can have a catastrophic effect on one's life, such as heart or kidney failure, according to Dr. Kim.
How to intervene
Beyond thinking of themselves as immediate responders, it's important for the public to have basic knowledge of how to intervene if they find themselves close to the scene of traumatic injury. Now, civilians can participate in a Bleeding Control Basics course, part of the Stop the Bleed campaign, learning what typically was considered military salvage and bleeding control. The course teaches tourniquet use for arm or leg wounds and wound packing with hemostatic gauze for neck, shoulder or groin injuries when a trauma first-aid kit is available or for arm or leg wounds when a tourniquet is unavailable. If a kit is unavailable, the course teaches wound compression with any clean cloth. Just as it is crucial for citizens to know CPR to assist someone in cardiac arrest, understanding and knowing how to use a tourniquet or wound compression to stop bleeding are critical civilian skills and a key mission of the ACS.
"It's incumbent upon people to prepare — take care of yourself first, and then help when you can," says Dr. Kim. "As a trauma surgeon, I'll take all the help I can get, and we're reliant on stopping the bleeding."
The golden hour — or the critical one-hour period for saving life and limb — starts immediately after the injury. This is especially true in the case of gunshot wounds, which are extraordinarily time-sensitive. When present at the scene of a trauma, citizens can intervene if they have learned the necessary skills; they have an opportunity to move the care forward for that patient.
How you can help as a trauma professional
One of the important roles of a trauma professional, according to Dr. Kim, is to make every effort to "put yourself out of a job." In other words, prioritizing trauma prevention education in your community is imperative, spreading awareness and training citizens to help stop hemorrhaging that could take an individual's life or have a devastating life effect.
To make an impact in a community with education and training individuals to help intervene at the scene of traumatic injury, a collaborative effort with trauma professionals, educators and public health personnel is needed. An engaged public is also critical, says Dr. Kim. "It's no good to shout it from the rooftops if no one is listening."
Bleeding Control Instructor Training, from the American College of Surgeons Committee on Trauma, is available for trauma professionals as well as non-health care professionals to help expand capacity for training community citizens to teach the Bleeding Control Basics course. Resources and class information are available through BleedingControl.org.
"The impact in a given community, knowing individuals have been part of these courses, is quite satisfying," says Dr. Kim. "It comforts me that this is propagating. Individual lives will be saved due to this small investment of time."
For more information
Trauma statistics and facts. National Trauma Institute.
Trauma facts. American Association for the Surgery of Trauma.
FastStats: Leading causes of death. National Center for Health Statistics.
Traffic Safety Facts. 2015 data. Summary of motor vehicle crashes (final edition). National Highway Traffic Safety Administration.
National Trauma Awareness Month. American Trauma Society.
Stop the Bleed. American College of Surgeons.
Bleeding control instructor portal. American College of Surgeons.